Thursday, April 6, 2017

Department of Health and Department of Corrections team up to provide health care coverage for newly released offenders

Pre-Release Medicaid Enrollment
Program for Offender Population

Author: Jennifer Katzman, Medicaid Program Manager

Numerous studies show that access to mental health, substance use and
other health care services helps former offenders better integrate back into
their communities, lessening the likelihood of these individuals committing future
crimes. Now, because of Medicaid expansion, the Louisiana Department of Health
and the Department of Corrections are helping incarcerated individuals enroll
into Medicaid, with coverage beginning once the individual’s sentence is
complete and they transition out of prison.

Nationwide, as well as in Louisiana, offenders enter prison with high
rates of mental illness, substance use disorders, chronic health conditions and
infectious diseases. While incarcerated, offenders receive care, but studies
show that almost all offenders who leave prison do not have health care
coverage, nor are they likely to find employment that offers coverage. Because
continuity of care is critical to better health, this is an especially
vulnerable population.

Under Medicaid expansion, states such as Louisiana can use enhanced
federal funding to make health care coverage available to individuals who are
transitioning out of prison. Coverage begins when the offender completes their
sentence and leaves prison. As we developed our program, we found other states
that already started similar programs found health coverage contributes to
better care continuity and also reduces the use of emergency rooms this
population typically uses for basic care.

The program is open to offenders between the ages of 19 and 64 who
become income-eligible for Medicaid while incarcerated under expansion. Income
changes (increases) will be considered once the offender is released.

In conjunction with the Department of Corrections (DOC), our agency
will implement pre-release enrollment of the offender population in phases
starting at the state level and then proceeding to local jails. There are
currently seven operating state prison facilities and 106 local jails that
house state offenders. In addition, local jails house local offenders.

The initiative started in January with DOC offenders in DOC facilities.
We are expecting that approximately 2,800 offenders will be enrolled in
Medicaid each year in Phase 1. Phase 2 will apply to DOC offenders housed in
local facilities (approximately 15,000 annually) and the final phase will
target offenders in local jails.

“This is a key solution to reducing Louisiana’s high incarceration
rate, reducing the state’s recidivism rate, keeping citizens safe, and saving
taxpayer money,” said Department of Public Safety and Corrections Secretary
James M. Le Blanc. “Nearly a quarter of the state’s offenders have serious
mental health issues, and 75 percent have substance use disorders. For every
dollar we spend toward treatment in the community, we save six dollars toward
criminal justice costs.”

The Department of Health and Department of Corrections began planning
for this program in late 2015. LDH and DOC developed an automated enrollment
process that allows the agencies to share information about offenders who are
set for release within the next nine months, and get them enrolled in Medicaid
and linked to a health plan pre-release. This enrollment process ensures that
the health plan insurance card is mailed to DOC in time for release so that the
former offender knows who to contact for access to care after release.

Dr. Raman Singh, DOC medical director, added that DOC identifies
offenders who have a high need for health care services for the Healthy
Louisiana plans to perform case management activities immediately prior to
their release to ensure a more seamless transition of care. This includes
offenders who use a wheelchair, or have a serious mental illness, co-occurring
substance use disorders, two or more medical conditions, HIV or other chronic
health conditions.

“As these individuals are identified, information is shared with the
Medicaid managed care plans which then develop care plans that include doctor
appointments and prescriptions. This is all included as a component of the
prison discharge planning,” said Dr. Singh.

LDH and DOC implemented phase one of the pre-release enrollment
initiative in January for offenders in the seven DOC state facilities. As of March
18, 2017, 450 offenders have been linked to a health plan, with about 77 who
are eligible for case management.